MOFFITT AM REPORT PEARLS 6/3/16: GENITOURINARY TB

  • 4-20% of patients with pulmonary TB have GU involvement
  • Presentation: insidious malaise and LUTS (dysuria, hematuria)
  • Pyuria and/or microscopic hematuria present in >90% of cases
    • Harry pearl: 1/3 microscopic hematuria, 1/3 pyuria, 1/3 both!
  • Dx is by symptoms, u/a findings, current/prior TB infection, and radiology
  • Limited dx utility of urine/urethral AFB smear since commensals exist (e.g. my favorite NTM organism, M. smegmatis!)
  • Can mimic pyelo
  • Thickening and fixation of ureter = “Pipe stem ureter” (characteristic of TB)
  • Radiology: Upper AND lower urinary tract involvement is characteristic of TB
    • Calcifications, calyceal distortion, strictures
  • Associated conditions: Interstitial nephritis, GN, secondary amyloid, obstructive uropathy

Thanks to Ali for bringing up a new diagnostic test called LF-LAM (lateral flow urine lipoarabinomannan assay) for detecting active TB in HIV-positive patients!

  • 2016 Cochrane review:
    • Low sensitivity for TB in HIV-positive pts whether used for screening or diagnosis
    • Combo of LF-LAM with sputum micro may increase sensitivity but decreases specificity
    • In HIV-positive pts with low CD4 counts who are seriously ill, LF-LAM may help with diagnosing TB
    • Cochrane Database Syst Rev. 2016 May 10;5:CD011420. doi: 10.1002/14651858.CD011420.pub2.

Link to Evernote:

https://www.evernote.com/shard/s272/sh/4e1730fe-f09a-4c9d-9ab7-d23eb04af485/bd2b5849a14f54938e1cf27328c57e69

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